Immunization Manual For Schools, Preschools, And Child .
Immunization Manual for Schools, Preschools and Child Care CentersPage 1Immunization ManualFor Schools, Preschools, and Child Care CentersRevised June, 2020Washington State Office of Immunization andChild ProfileP.O. Box 47843Olympia, WA h.wa.govTo request this document in another format, call 1-800-525-0127. Deaf or hard of hearing customers, pleasecall 711 (Washington Relay) or email civil.rights@doh.wa.gov.DOH 348-124 June 2020
Immunization Manual for Schools, Preschools and Child Care CentersPage 2AcknowledgementsWashington State Department of Health,Office of Immunization and Child Profile staff:Kathy Bay, DNP, RN, CENPClinical, Quality, Epidemiology, and Schools Section ManagerJennifer Coiteux MPA, LSSBBInterim DirectorHannah Febach, MPHSenior Policy AnalystChas DeBolt, RN, MPHVaccine-Preventable Disease EpidemiologistJafar ZahirImmunization Assessment CoordinatorPhillip Wiltzius, MS, CHESHealth EducatorKatherine Graff, BSN, RNSchool and Child Care Immunization Nurse ConsultantTo request this document in another format, call 1-800-525-0127. Deaf or hard of hearing customers, pleasecall 711 (Washington Relay) or email civil.rights@doh.wa.gov.DOH 348-124 June 2020
Immunization Manual for Schools, Preschools and Child Care CentersPage 3Table of ContentsManual Overview . 4Responsibilities . 5Vaccine Requirements . 9Immunization Records . 14Requirements for Special Types of Students. 20Required Annual Immunization Reporting. 23Required Parental Notification . 25Washington State Immunization Information System (IIS) . 26Disease Prevention and Control. 28Vaccine Recommendations for Staff . 29Additional Resources . 31List of Changes to this Manual . 33To request this document in another format, call 1-800-525-0127. Deaf or hard of hearing customers, pleasecall 711 (Washington Relay) or email civil.rights@doh.wa.gov.DOH 348-124 June 2020
Immunization Manual for Schools, Preschools and Child Care CentersPage 4Manual OverviewThe Immunization Manual for Schools, Preschools, and Child Cares 1 is a reference guidefor school and child care staff who process Certificate of Immunization Status andCertificate of Exemption forms, complete immunization status reports, and answerquestions from parents and guardians about immunization requirements for children .Many of you deal with immunizations every day and are expected to know a lot aboutthem. This manual will help you.You can find the manual on the Department of Health’s Office of Immunization and ChildProfile Web site at: www.doh.wa.gov/SCCI. While you may want to print the manual andplace it in a three-ring binder, we suggest you access it electronically to get the mostup-to-date information.The manual can help you: Understand Washington State immunization requirements for children attendingschool, preschool, and child care.Work successfully with parents, school administrators, and healthcare providersregarding immunization regulations.Answer questions about the immunizations a child needs for school, preschool andchild care.Prepare the required school and child care Annual Immunization Status Report.Report communicable diseases at your school, preschool, or child care to local publichealth officials.Work with public health officials during a disease outbreak.Find immunization resources.1“Preschools and child cares” in this manual include: preschools and child care centers associated with public andprivate schools, Head Start/ECEAP programs, licensed in-home child care, licensed child care centers, andchildren’s group homes.To request this document in another format, call 1-800-525-0127. Deaf or hard of hearing customers, pleasecall 711 (Washington Relay) or email civil.rights@doh.wa.gov.DOH 348124 June 2020
Immunization Manual for Schools, Preschools and Child Care CentersPage 5ResponsibilitiesMany organizations and individuals have responsibilities for immunizing children and students inWashington State. See below for specific responsibilities.Parents/GuardiansParents, foster parents, and guardians are responsible for their child meeting immunizationrequirements. Parents should keep accurate and up-to-date immunization records for theirchildren. Parents must submit a complete and medically verified Certificate of ImmunizationStatus (CIS) to their child’s school, preschool, or child care before the child can attend . SeeWAC 246-105-050 for more information.Health Care ProvidersThese licensed health care providers can prescribe vaccines:Medical Doctors (MD)Doctors of Osteopathy (DO)Naturopathic Doctors (ND)Licensed Physician’s Assistants (PA)Nurse Practitioners (ARNP) with prescriptive authorityPharmacistsHealth care providers are encouraged to immunize patients according to the most currentCenters for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP)recommended immunization schedules. Health care providers: Educate parents and guardians about communicable diseases and immunizations. Thisincludes giving them a current Vaccine Information Statement (VIS) for each vaccineadministered.Give information on the benefits and risks of immunization to parents or guardianswanting to exempt (excuse) their child from immunization requirements. Health careproviders licensed in Washington who are physicians (M.D.), physician assistants (P.A.),osteopaths (D.O.), naturopaths (N.D.), and advanced registered nurse practitioners(A.R.N.P.), meet the definition of health care practitioner and can sign the officialCertificate of Exemption or write and sign a letter containing the same information. Ahealth care practitioner who, in good faith, signs the statement that they haveprovided the parent with information about the benefits and risks of immunization forthe child is immune from civil liability for providing their signature. See RCW28A.210.090 for more information.Must provide parents with a written record of immunizations administered, as noted inRCW 28A.210.100. Providers can print the Certificate of Immunization Status (CIS)with the child’s immunization history if they have access to the Washington StateImmunization Information System (WAIIS).May sign a hardcopy CIS to verify that the immunization dates written on the CIS areaccurate.The Health Insurance Portability and Accountability Act (HIPAA) privacy rule permits providers todisclose proof of required immunizations to a school with agreement from the parent orguardian. The agreement may be obtained orally or in writing, and need not be signed or containthe other elements required in a formal, written HIPAA authorization. More information about theHIPAA Privacy rule and student immunizations can be found at: e/student-immunizations/index.html.To request this document in another format, call 1-800-525-0127. Deaf or hard of hearing customers, please call 711(Washington Relay) or email civil.rights@doh.wa.gov.DOH 348-124 June 2020
Immunization Manual for Schools, Preschools and Child Care CentersPage 6School, Preschool, and Child Care StaffAdministrators in these facilities have final responsibility when it comes to immunizationcompliance. It is the duty of the administrator, by law, RCW 28A.210.120, to exclude childrenfrom school, preschool, or child care if they do not meet immunization requirements.Administrators may designate other staff to do immunization compliance tasks, such asnurses, health assistants, secretaries, or volunteers. Schools, preschools and child caresshould have policies to protect confidential information such as immunization records.It is the responsibility of schools, preschools, and child cares to do the followingimmunization compliance tasks: Review Certificate of Immunization Status (CIS) forms to ensure they are medicallyverified. Have a school administrator, school nurse or their designee who can verify a hardcopyCIS with attached medical immunization records and sign it to verify its accuracy. Review Certificate of Exemption (COE) forms to ensure they are completed correctly. Create a filing system for the required CIS and COE forms, such as alphabetizing bygrade level, name, or other system to make it easier to keep the immunization recordsup to date. Identify students who are missing required immunizations and contact parents forfollow-up to maintain the conditional status timelines. Exclude children who do not meet the immunization requirements. Identify and keep a list of susceptible students (students with an exemption or missingdoses) to use in the event of a disease outbreak. This list must be transmitted to the localhealth department within 24 hours upon request. Keep track of staff vaccinations or remind staff that they may need to provide theirimmunization records in the event of an outbreak. Teach staff and parents about the importance of getting immunized. Follow state immunization laws and school requirements. Links to the applicableRCW’s and WACs can be found at www.doh.wa.gov/SCCI.Local Health JurisdictionsSeveral local health jurisdictions (LHJs) administer immunizations. Some give out Certificatesof Immunization Status, other immunization forms, and materials about communicabledisease and immunization rules. Public health officials have the responsibility to work withschools, preschools, and child cares to prevent and control outbreaks of vaccine preventablediseases. They also work with health care providers to maintain or improve immunizationrates in their communities. In the event of a disease outbreak, the health officer of the LHJ isthe only person with the authority to exclude children and staff from school, preschool orchild care. You can find local health jurisdiction websites and contact information ealthJurisdictions.State AgenciesDepartment of HealthThe Office of Immunization and Child Profile at the Washington State Department of Healthtracks immunization levels in the state as part of a federal requirement. Staff answerquestions about the immunization requirements and are a resource for vaccines and vaccinepreventable diseases. The office has the responsibility to develop the Certificate ofImmunization Status and Certificate of Exemption forms, and align the ages and vaccinationintervals specified in the national immunization guidelines with a corresponding grade level.Public health staff may review school, preschool, and child care facility immunization recordsto ensure they comply with state regulations, per RCW 28A.210.110.To request this document in another format, call 1-800-525-0127. Deaf or hard of hearing customers, please call 711(Washington Relay) or email civil.rights@doh.wa.gov.DOH 348-124 June 2020
Immunization Manual for Schools, Preschools and Child Care CentersPage 7State Board of HealthThe State Board of Health has the authority to make immunization rules. These rules includethe immunizations children must have in order to enter school, preschool or child care,procedures for complying with a schedule to achieve full immunization, and the documentationrequired for proof of immunization. See RCW 28A.210.140 for more information.State Board of EducationThe State Board of Education has the authority to establish the rules governing the exclusion ofstudents from private schools for failure to comply with the immunization requirements. SeeChapter 180-38 WAC for more information.Department of Children, Youth and FamiliesThe Department of Early Learning has the authority to establish rules governing the exclusionof children from child care for failure to comply with the immunization requirements . Theyenforce immunization rules for licensed preschools and child cares. See Chapter 110-300WAC for more information.Office of the Superintendent of Public InstructionThe Office of the Superintendent of Public Instruction (OSPI), in consultation with the StateBoard of Health, has the authority to establish the rules governing the exclusion of studentsfrom public schools for failure to comply with the immunization requirements. See WAC 392-380050 for more information. They also: Provide information to public schools about immunization requirements and how toproperly contain contagious diseases at schools.Adopt rules regarding immunization records of transferring students. See WAC 392182-020 for more information.Consult with the Department of Health (DOH) to prepare information for schools tocomply with the law. For example, OSPI consults with DOH for information onmeningococcal and human papillomavirus. Schools are required by law to send thisinformation to parents or guardians.Consult with school districts on immunization issues.To request this document in another format, call 1-800-525-0127. Deaf or hard of hearing customers, please call 711(Washington Relay) or email civil.rights@doh.wa.gov.DOH 348-124 June 2020
Immunization Manual for Schools, Preschools and Child Care CentersPage 8The network of partners involved in childhood immunization is shown below.Parents/Guardians must: Comply with immunizationregulations.Healthcare Providers must: Administer vaccines according to the RecommendedImmunization Schedules Provide a record of administered vaccines.Administrators ofSchools, Preschools,and Child Cares must: Check complianceand exclude noncompliant childrenand students.State AgenciesDepartment of Healthmust: Monitor state levels ofimmunization. Review annual statusreports. Act as a resource forimmunizationinformation.State Board of Healthmust:Adopt state rules forimmunizationrequirements.Child/Studentgets immunizedDepartment of Children,Youth and Familiesmust: Develop regulations forexclusion of children inChild Care.Office of theSuperintendent ofPublic Instruction must: Provide informationabout the requirements Develop regulations forimmunization recordtransfer and exclusion ofstudents in publicschool.State Board ofEducation must: Develop regulations forexclusion of students inprivate school.Local Health Jurisdictionsmay: Administer vaccines. Distribute Certificates ofImmunization Status andother immunizationinformation. Prevent, investigate, andcontain disease outbreaks.Healthcare Staff atSchools, Preschools,and Child Cares must: Communicaterequiredimmunizationinformation toparents. Collect and assessimmunizationinformation. Follow-up withparents if needed. File Certificates ofImmunizationStatus. Exclude students outof compliance withthe immunizationrequirements. Complete annualstatus report.To request this document in another format, call 1-800-525-0127. Deaf or hard of hearing customers, please call 711(Washington Relay) or email civil.rights@doh.wa.gov.DOH 348-124 June 2020
Immunization Manual for Schools, Preschools and Child Care CentersPage 9Immunization RequirementsSchool, preschool, and child care staff can help to protect children against serious diseasesby encouraging full and timely immunization. Help parents understand that: Each child must have a record of his or her immunizations on a medically verifiedCertificate of Immunization Status (CIS) or have a completed Certificate ofExemption on file for each of the diseases for which full immunization is required. Immunizing on time gives children the best protection. Immunization requirements in schools, preschools, and child cares have been shownto increase immunization coverage. Communicable diseases still exist and international travel can bring diseasescommon in other parts of the world to our communities. Keeping up-to-date records at home and at school is vital. All children under the age of 19 can get immunizations at no cost in our state.Providers may charge an administration fee, but they must waive the fee if asked bythe parent.Recommended Versus Required ImmunizationsNot all of the immunizations recommended for children are required for school or child care entryin Washington. These definitions can help: Recommendations: The Centers for Disease Control and Prevention (CDC) AdvisoryCommittee on Immunization Practices (ACIP) makes vaccine recommendations thatproviders follow as the “best practice” to get the best protection from vaccine preventablediseases. The ACIP updates the recommended immunization schedule annually.Requirements: State law requires children to have documentation of full immunity tocertain diseases to enter school, preschool, and child care. See RCW 28A.210.080 formore details.o The law directs the State Board of Health (SBOH) to determine which diseaseschildren must have immunity against. The SBOH writes the rules in theWashington Administrative Code (WAC). The rule says a child documentingimmunity though vaccination must be vaccinated according to the ages andvaccine intervals set forth in the ACIP recommended immunization schedulepublished in a specific year. The WAC may not always reference the most recentlypublished ACIP schedule. See Chapter 246-105 WAC for the currently referencedschedule.o The SBOH directs the State Department of Health to align the ages andintervals specified in the ACIP schedule with a corresponding school grade level.Required Immunizations:According to the Washington Administrative Code WAC 246-105-030, any child attendingschool, preschool, or child care in Washington State is required by law to be fully immunizedagainst the following diseases:Chickenpox (Varicella)MumpsDiphtheriaPneumococcal disease*German measles (Rubella)Polio (Poliomyelitis)Haemophilus influenzae type b disease (Hib)*TetanusHepatitis BWhooping cough (Pertussis)Measles (Rubeola)*required only for preschool and child care attendanceTo request this document in another format, call 1-800-525-0127. Deaf or hard of hearing customers, please call 711(Washington Relay) or email civil.rights@doh.wa.gov.DOH 348-124 June 2020
Immunization Manual for Schools, Preschools and Child Care CentersPage 10Vaccine Requirement Charts and ResourcesThe Washington State vaccine requirements charts and the Individual Vaccine RequirementsSummary (IVRS) are updated each school year and are available at www.doh.wa.gov/SCCI.To document immunity by vaccination, children must have the vaccine doses required in theapplicable chart below. The vaccine doses must be given at the appropriate ages and intervals.Documentation of vaccination given to schools or child care centers must be medically verified. Vaccines Requirement Charts for School Attendance, Grades K-12There are vaccine requirement charts for school attendance in grades K-12. There is anEnglish version for school staff, and parent versions in multiple languages. To find the doses required in the chart, look at the column that includes the student’sgrade and match it with the row for
children. Parents must submit a complete and medically verified Certificate of Immunization Status (CIS) to their child’s school, preschool, or child care before the child can attend. See WAC 246-105-050 for more information. Health Care Providers These licensed health care providers can
time, nature preschools also build children’s connections to the places where they live and boost children’s confidence in working together to improve their world, creating the foundations for lifelong environmental literacy. Nature preschools may be called nature-based preschools, place-based schools,
Immunization Manual for Schools, Preschools and Child Care Centers Page 5 To request this document in another format, call 1-800-525-0127. Deaf or hard of hearing customers, please call 711
and Influenza Immunization Summit (NAIIS) is pleased to announce the recipients of the 2016 Immunization Excellence Awards. There are six categories of recognition: overall influenza season activities, influencer, "immunization neighborhood" champion, corpo-rate campaign, adult immunization champion, and adult immunization publication award.
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The Kentucky Immunization Registry is an IIS Statewide Immunization Information System (IIS) Information system that houses immunization data on Kentucky residents across-the-lifespan record keeping (birth to death) Allows providers the ability to access and retrieve immunization records prior to or at the time of a scheduled appointment.
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